 Image: pixabay So this was exciting! But also probably the most nerve wracking thing I've done since jumping out of a plane!
Penny Johnston, has a program called Babytalk that is part of the ABC radio network. She invited me in to talk about getting back into exercise after having a baby. We discuss what happens physiologically to your body when you are pregnant and whilst you are recovering postpartum, and some of the challenges new mum's face getting back to exercise. Click the link below to have a listen!
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I have a bone to pick with expectations. I first learnt about them on a student exchange trip to France at the age of 17. It was meant to be “amazing”, a “once in a lifetime experience”. Instead it was lonely and difficult. I found myself in a world where I could not express myself and as a result became an outsider, that awkward person that hangs on to groups of people without contributing. I became depressed and felt guilty for squandering this “amazing” experience with my own genuine feelings. I was so disappointed and let down by my experience and felt the blame lay squarely on my unrealistic expectations. This spurred a realisation for me. Expectations can ruin an experience. Not once in the lead-up to my 2 months abroad did anyone say to me: “you’ll feel really lost”. Instead it was “you’ll find yourself”. Well, I found more of my physical self as I made a daily trip to the patisserie to fill my emotional void with sugar coated almond croissants. But unfortunately, I had never felt more insignificant.  Yum! Image by Faruk Ates Looking back, I still think it was a valuable experience, but it should have been just that…an experience, not “the time of my life”. I think that actually goes for most major events in life. I had a similar experience following the birth of my first child, Lily. The most common question I was asked during my pregnancy was: “Are you excited?” After hearing this for the 20th time, my response was reactionary and immediate, I would break out the big smile, nod profusely and explain I couldn’t wait. And it was the truth. But the effect of this question was like hypnosis for me. It solidified my subconscious thinking that parenthood was meant to be, and going to be ‘exciting’. Even if I may have read a chapter on settling, or listened to the antenatal session on juggling time in the post-natal period, these concepts were abstract and hard to tangibly imagine. The overwhelming emphasis from my world was that this was going to be the most exciting and rewarding journey of my life. Then, diagnosed with post-natal depression when Lily was 6 months old, I was perplexed. This was meant to be exciting and rewarding. Why was I finding it so difficult? How is it, that millions of women have done this mothering caper the world over, and I feel it is beating me? I was young, healthy, fit, and educated. I had read the books and attended the classes. At my kinder graduation aged 5, my teacher proudly announced I wanted to be a mum when I grew up. BRING IT ON!! The reality…you all know it, turn on the broken record. Tired beyond all scope of possible imaginings, feelings of defeatism as a tiny person up-ends your life and makes you feel inadequate, body changing issues, a feeling of distance with your partner, watching your friends go overseas and earn money and attend trendy wine tasting events. I was expecting this:  But I was experiencing this:  Image: shoeboxblog.com I thought there was something wrong with me. Now I know, there wasn’t. My expectations were just so far from reality that I had lost before I had even begun. I tried to keep up the performance of being on top of everything and “happy”. It was EXHAUSTING. But why did I do it? I’m still not entirely sure. Maybe because I didn’t want to let down everyone who was telling me how happy I should be. Maybe because people don’t want to visit you when your a vomit-stained, un-washed, teary mess who keeps falling asleep. Maybe because I thought I’d fool myself if I kept on the hamster wheel. Did it work? Yeah, maybe. Sort of. Not really. What did work? Talking. Well for me anyway. Mothers’ group was brilliant. 8 other mum’s right there in the trenches with me, sleep deprived, angry at our husbands, feeling like slaves to our 6 months olds. It was gold. We used to open a bottle of wine at 12.30PM and get it all off our chests. Then I had to talk to a psychologist for a bit as well. Similar issues, less wine and more expensive; but also very helpful. Should 1 in 7 mums experience post-natal depression? It seems wrong to me. So, I find myself asking, what are we doing as a culture, as a society that makes this feeling of defeatism and sadness so profoundly common in new mums? Unrealistic expectations are playing their part. Unrealistic expectations of happiness, of fulfilment, of love, of connection with your partner, of physical recovery. And unrealistic expectations and understanding of the enormity and loneliness of the mother workload. So, as a community can we moderate this expectation? I think we can. It’s not about bringing all pregnant women down and telling them depressing stories about motherhood. But let’s just say it how it is. There are high’s and there are low’s. Let’s ask open ended questions to pregnant or new mums such as “How are you feeling about becoming a mum?” to allow them to express themselves, rather than ramming pre-packaged emotions into their psyche. None of this is to say it’s not worth it. And for goodness sake, share your lovely stories about your children too. But don’t sugar coat parenthood. Don’t watch too many nappy ads that make being a mother look like running through an immaculate house in white pants while your perfectly clean child giggles constantly. Sure, there is the odd moment like that (FYI: you’re mad if you wear white anything as a mum, and my house has never been immaculate since becoming a parent) but the bare bottomed giggles and the cuddles do happen, and are awesome! As a community and society, let’s help to put expecting parents in a frame of mind that acknowledges the road into parenthood not as “the time of your life” but for what it is, an experience.   Do you wee more than every 2 hours? Do you wake up overnight to wee? Do you make sure you go to the toilet before you leave the house? Do you rush to the toilet as soon as you get in the door?
If you answered yes to any of the above questions, you are not using your bladder correctly, and you could be setting yourself up for conditions such as:
The bladder’s job is to fill, store and then empty urine. The bladder is a muscle, called the detrusor muscle. Which means it’s really good at stretching, then forcefully contracting and rebounding to it’s normal shape. And it does this over and over and over, every day of our lives. Within the wall of the bladder, there are baroreceptors, or ‘pressure receptors’ that feedback information to our brain about how the bladder is filling. Once these messages get loud enough, they come to our conscious attention, and we get the urge to go to the toilet. Once on the toilet, our brain sends a message to the bladder to contract, and the bladder muscle squeezes all our urine out. Sounds simple right? And it can be. But the bladder muscle, like every muscle in our body, contracts best within a certain range of motion. Or, in the case of the bladder, within a certain volume of urine. So, why do we care if our bladder is, or isn’t contracting at it’s best? If the bladder is not filled enough, then the detrusor muscle is unable to generate sufficient force to expel all the urine, and we can experience; poor urine flow, increased post-void residual (the amount of urine left in the bladder after emptying), urinary frequency, and increased risk of urinary tract infections. Additionally, over time, if the bladder is never allowed to fill up and stretch, the detrusor muscle becomes stiff and can become unable to hold decent urine volumes. This can progress to symptoms such as urinary urgency, urinary frequency, nocturia (waking more than once per night to urinate), and urinary urge incontinence. Now, don’t get too carried away on the big wee’s, bigger is not always better. If you repeatedly over-stretch your bladder muscle, you end up with lazy pressure receptors that forget to send your brain the message that your bladder is filling. Also, your bladder ends up looking like a deflated balloon and this also can result in poor urine flow, poor emptying and urinary urgency. So, hopefully now you are asking “What is this magic volume that I need to be wee-ing at every toilet stop?” Drum roll please…..Optimal bladder habits are as follows: 250-500mls per wee 5-6 wee’s per day 0-1 wee per night. So, how do you find out if this is what you are doing? Grab yourself a measuring device (preferably a dedicated one you have purchased for the task, and not the kitchen measuring cup), measure and write down your wee’s for at least a 24hour period. If you fall within the above range, give yourself a pat on the back (or bladder) and move on. If not, make the time to speak to a continence professional such as a urologist, continence physiotherapist or continence nurse and find out what is causing your less than optimal bladder habits, and how to fix them. Unfortunately, we know that poor bladder habits or urinary symptoms such as urgency, frequency and incontinence get worse over time unless they are treated. So seek treatment sooner rather than later.  She came from my being. Started as a seed, always there. Never apart. Her number was chosen, she won and thrived; My bread was her bread, my lungs, her air. She was me. There was no divide. My rhythm was her lullaby. We became an alien, a two headed, strong willed force of nature. She came with a purpose, perfect from the start. She breathed her own oxygen and her blood pumped red. I didn’t think twice when they cut her physical bond to me. It didn’t even bleed a tear. We smiled. Why didn’t I mourn that more?  She did not recognise herself, rather knew herself only in relation to me. Without my body, my scent, my sounds; she was lost. My milk sustained and nourished her. She grew fat on it. She was physically, completely a product of my body. I was her world. It came with responsibilities; some of which were terrifically, physically, emotionally challenging. Others that were utter gluttony in their delight. And all she wanted was me, we were so wrapped in each other, We may as well have been one and the same. And we were.  She took food from a spoon and I mourned a little loss, Gone was the monopoly I had on her creation. She carried on the job of children; to grow and learn and become. Become a personality, an individual, an identity, a person. She found her voice, a beautiful husky utterance that I recognised as my own. We watched her stumble out her first steps and babble out her first words. Steps became skips and words became songs. She was blooming. And so was our love.  And all this time, she had been observing, Drinking in language, gestures, concepts. Lapping up information and gathering opinions. Lots of them mine, but then, a word I do not say, or a gesture that is foreign. There is a dart of panic. A loss of control. An extension of the cord Now she is at school. Now the tables have turned. I am here for food, for clothes, for transport, for sleep. But there are many hours and many teachers and many friends, shaping my baby. This walking, talking, running, jumping, skipping, thinking, writing, reading; baby of my body.  Then there are the moments before dawn, a little tip toe down the hall
There is a soft little voice and hand and she is curled in my body once again. Later, she will make her breakfast, dress herself, and run with friends But in this moment, rarer by the day, she has come home to rest. She is beautiful and she is mine. But when did she become apart from me? I will never know. And I will not hold her back. Though she may travel far and wide, She is my baby of my body, and always she will be. “But if my muscle is tight, why am I still leaking?” This is a great question. And the best way to answer it is to imagine we are talking about a different group of muscles in your body, such as your neck muscles.  Most people will have experienced a sore and painful neck at some point in their life. And when you’ve had that sore neck, it’s often hard to turn your head, or you do so with trepidation, much more slowly than usual. Well, I bet during this uncomfortable time, you’ve also reached up to rub your sore neck and possibly touched the major muscle groups that are responsible for these neck movements. Did you ever notice how tight and hard they seemed under your fingertips? So, we have a sore neck, we have tight muscles and we have loss of function. This is exactly what is happening in your pelvic floor.  Most often, something will have occurred in the pelvis to cause your pelvic floor muscles to became overactive and tight. This incident may have been, for example: a painful experience with constipation, a history of recurrent urinary tract infections or thrush, or an uncomfortable sexual experience. As a result, sometimes the pelvic floor muscles will go into spasm, or the individual may begin holding tension in the pelvic floor muscles as a way of subconsciously providing protection to the area. This causes the muscles to become short and stiffened. When muscles are held in a shortened position, they have less ability to contract and perform their function in a responsive and timely manner. If we go back to the example of our neck; turning your head (which is the function of the neck muscles), may be reduced, and will be performed more slowly in the presence of tight, stiff neck muscles. In the case of the pelvic floor, the ability to engage and contract to support the bladder and occlude the urethra (which is the function of the pelvic floor), will also be reduced, and will be performed more slowly when the muscles are tight and stiff, and this will lead to urinary leakage.  So, if this is the case, asking this woman to do lots of pelvic floor exercises focused on squeezing and holding is not going to improve her urinary leaking. In fact, it may make it worse, or give her a new condition due to even more spasming in her pelvic floor muscles.
Instead, what will assist this woman is if she can learn to downtrain the muscle tension. This can be taught and practiced and once we have a healthy muscle, sitting at a good resting length, we can then teach appropriate functional recruitment of the pelvic floor which will lead to long lasting continence. |
Welcome!Hi! Welcome to The Blog! Please be aware, Womankind Physiotherapy's blog is not intended to replace information and advice from your health care provider. For specific concerns regarding your health you must seek individualised care by your preferred provider.
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